Registration

2011 Registration Form Hockessin Dance Center, Inc. Please complete one for each child.

Student's Full Name:

* required

Age:

* required

Birthday:

* required

School and Grade:

* required

Does the student have any allergies or medical conditions we should know?

Yes

No

(List if any)

New/Returning Student

New Student

Returning Student

How did you hear about HDC?
If Reffered by a friend, please enter the students name below.

Email Address:

* required

Student's Email Address:

Parent/Guardian's Name:

* required

Relationship to Student:

Full Address (including street, city, state and zip)

Home Phone:

* required

Cell:

* required

Additional Phone #:

Emergency Contact (other than parent/guardian)

* required

Relationship to Student:

Phone #:

* required

2012 Summer Schedule
to select multiple classes, hold Ctrl and click
or you can list classes in "Other"

2012 Dance Schedule
to select multiple classes, hold Ctrl and click
or you can list classes in "Other"

Other...

Pageant/Audition Dance Package

Private Lessons

Gift Certificate

Comments:

Photo Release

click here to read photo release form

Click below to be taken to a secure website if you would like to make a credit card payment.

Cash and Checks will still be accepted by mail or at HDC

Monthly Class Payment - Hockessin Dance Center

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